Streptococcal Pharyngitis
S. pyogenes
Amoxicillin 50mg/kg PO q24h (max 1000mg/dose)
OR
Penicillin VK 50-75mg/kg/day PO div BID (max 500mg/dose)
OR
Benzathine Penicillin
</=27kg: 600,000 units IM once; >27kg: 1.2 million units IM once1
Penicillin Allergic Patients (non-severe reaction history):
Cephalexin 40mg/kg/day PO div BID (max 500mg/dose)
Penicillin Allergic Patients (severe reaction history):
Azithromycin 12mg/kg PO q24h (max 500mg/dose)
OR
Clindamycin 21mg/kg/day PO div TID (max 300mg/dose)
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Do not test if patient has concurrent viral URI symptoms (rhinorrhea, cough).
Therapy is important to prevent rheumatic heart disease as well as the purulent complications of strep pharyngitis.
Penicillin VK has the advantage of having a narrower spectrum, but amoxicillin has better GI absorption and young children tolerate amoxicillin suspension better. PenVK a good choice in your adolescents that take pills!
Length of Therapy:
10 days (5 days for azithromycin)